Understanding the ACA Attestation Requirements & How to Comply

What is the CMS ACA Attestation eligibility requirement?

The Centers for Medicare & Medicaid Services (CMS) issued a requirement that all health insurance agents must obtain an attestation from Marketplace ACA consumers. 

This requirement aims to “ensure the consumer is aware of what they are agreeing to and that they have confirmed the accuracy of the information in their Marketplace eligibility application prior to submission.” Requiring an Attestation is another step toward creating more transparency about the health insurance process and ensuring your clients understand the coverage they are receiving. 

Although similar to the ACA Consent to Contact, it’s important to note when each comes into play. An agent should gather Consent at the beginning of working with a new prospect. An agent should gather the Attestation after the quoting and enrollment process but before completion. 

Currently, CMS doesn’t require a specific Attestation form to obtain agreement. However, here are the main pieces of information your team’s form should have:

• The date the information was reviewed by the consumer/client
• The name of the consumer/client (or their authorized representative)
• An explanation of the attestations at the end of the eligibility application
• The name of the agent/broker

How to Comply With ACA Attestation Regulations

Similar to the ACA Consent to Contact compliance rule, agents can obtain attestations in one of three ways:

• Verbally
• Electronically
• In Person

Regardless of which option you choose, ensure you include the elements listed above to comply with CMS Attestation regulations.

However, obtaining the Attestation is only the first step. You must also maintain the Attestation record. Often this means using a solution like:

• A local filing cabinet for written records
• Electronically-based file folders or a cloud-based file repository (i.e., Dropbox, Google Drive) for electronic files (including call recordings)
• An agency management system (AMS) or CRM

When considering where to store your records (digital files, phone recordings, and paper files), here are some things to keep in mind:

• Access: A local filing cabinet can make access easy for your team when in the office. However, those files are not accessible when you’re on the go. An electronically-based file repository system, an AMS, or a CRM can improve on-the-go access and centralize all of that data to one location. 
• Security: In addition to security for PPI documentation, it’s essential that your team has a secure place to store Attestation records. To be HIPAA compliant, a file cabinet must be locked at all times, among other requirements. Ask your technology vendor to learn more about security for all digital document storage options, including electronic file repositories, an AMS, or a CRM.
• Organization: Growing books of business must be organized. On-site and digital file systems can manage documents easily and organize them by specific filters. However, they don’t tie those documents to other records for individuals, groups, agents, etc., which makes data management much more difficult. An AMS or a CRM can simplify this process and connect all related data and documents for a comprehensive view of each individual, group, agent, etc.

How to Obtain ACA Attestations Using AgencyBloc's AMS+ Solution

Using AgencyBloc’s AMS+ solution, your team can gather ACA Attestations in a few different ways:

• Electronic Compliance: Generate and send ACA Attestations directly from AMS+ — both in English and Spanish. Once the Attestation is signed, it’ll be stored in the contact’s profile for easy access. Maintain other compliance needs like Medicare Scope of Appointment and ACA Consent to Contact in AMS+ as well.
• Insurance VoIP: Automatically record all calls made to and from AgencyBloc’s AMS+ VoIP phone dialer system. These recordings will also be stored in the contact’s profile. 
• Built-In Video Conferencing: Use the built-in meeting scheduler and video conferencing tools in AMS+ to schedule and virtually meet with prospects and clients. Similar to the above, these recordings are also stored in the contact’s profile.

Posted by Allison Babberl on Thursday, October 24, 2024 in Health Insurance

1. compliance management
2. data management
3. selling